This proposal seeks to identify modifiable risk factors that may be causally related to the approximately 1,000 occupational fatalities annually directly related to commercial driver crashes, and some of the 3,500 additional crash deaths attributed to other factors; thus it has high impact potential. Additionally, this research housed within a K01 proposal that brings together established researchers from multiple disciplines and crafts an educational plan to advance my research career in an area with little research. Candidate: The K01 award will afford me the opportunities to design, initiate and complete a high-quality research project under the mentorship of my primary mentor (Dr. Hegmann) as well as other members of a multidisciplinary Advisory Committee. A K01 grant will be a vehicle in my personal development to become a successful investigator. It is the springboard to my central goal of producing high-quality R01 proposals in injury prevention in occupational health and safety, to further the body of knowledge and help workers to be both safer and healthier. Mentorship: This career development plan includes both didactic and experiential educational elements in addition to the research plan. K01 Mentoring Advisory Committee is comprised of: Kurt T. Hegmann (primary mentor), MD, MPH. University of Utah, Stefanos Kales, MD, MPH. Harvard University, Richard Hanowski, PhD, Virginia Tech Transportation Institute, Richard J. Porter, PhD, ME, University of Utah, Costas Christophi, PhD, MS. Cyprus Institute in Association with Harvard School of Public Health and Gary Moffitt, MD. Road Ready Inc. The mentoring committee has already had several discussions about this proposal and the logistics required. Therefore, the committee is already formed and functioning. Research plan: The goal of my research plan is to quantify individual and environmental risk factors of commercial truck drivers involved in non-fatal and fatal crashes compared with drivers who were not involved in a crash, in a large (n=119,670) retrospective cohort study. This research plan will merge three considerable existing data sets, the Federal Motor Carrier Safety Administration (FMCSA) crash data set, JB Hunt Transport occupational exposure data, and the Road Ready data set of 119,670 Commercial Driver Medical Exams (CDME). Road Ready data set is a large and continuously growing data set of CDMEs performed as part of a driver's medical certification. It is estimated that at the time of analyses, there will be approximately 372,123 person-years of data to be used for calculating proportional hazard ratios for time to event for a crash. Additionally it is estimated that at the time of analyses there will be approximately 119,670 total drivers; 113,019 without a crash, 6,464 drivers with at least one crash, and 187 fatal crashes. We will analyze all data from the CDME, particularly including demographics, medical history, body mass index and related measures of obesity, controlling for other factors including miles driven. These data will be used for all three data sets; those involved in fatal crashes, those not involved in any reported crash, and those involved in non-fatal crashes. The most recent examination for each crash report (there may be multiple non-fatal crashes) will be utilized. The FMCSA data are available from January 1st, 1989 through the current time. There are approximately 2.2 million crash records to as of Feb 2010. For the time that overlaps with the Road Ready data set (January 1st 2004 through the current time) there are more than 800,000 crashes in the MCMIS data. Additional data from J.B. Hunt Transport Inc. will be incorporated into these analyses. These data are for a large subset of drivers who have CDME data in the Road Ready data set (approximately 28,000 drivers). These data include driving experience, type of driving, miles driven, and segments driven. Analyses for occupational and non-occupational factors will include comparisons between; Non-fatal crashes relative to general truck driving population not involved in a crash, Fatal crashes relative to general truck driving population not involved in a crash, and Fatal crashes relative to non-fatal crashes Questions to be addressed with this proposal: What are the associated factors for involvement in a non-fatal crash (hypothesis 1) What are the associated factors for involvement in a fatal crash (hypothesis 2) What are the associated factors that differentiate a fatal crash from a non fatal crash (hypothesis 3)